James D's Heart Valve Journal

My mitral valve repair surgery was two years ago today. I rarely think of it any more, it seems so far behind me.

I am doing great. I’m in excellent physical shape and my heart is humming along beautifully. I had my annual physical last month where I had to remind my physician that I’d even had the surgery after he listened to my heart and moved right on to the next thing. He went back and listened again, announcing that I had a slight murmur— a result of the tiny leak that’s still there. And that’s fine; everyone knew and expected that. I saw my cardiologist last summer. He told me I was doing extraordinarily well and didn’t need a routine checkup for another 18 months.

The only thing that reminds me I’ve had the surgery is an occasional jolt of pain from the sternotomy. I’d been told this could happen for a while, though it has gotten much less frequent. It’s not bad and doesn’t last long, so I can easily live with it. One other thing is dreams. There were the bizarre drug-induced dreams which went away as soon as I stopped taking Percocet. Then there are the more persistent and bothersome dreams that I’ve learned often follow surgery. These, too, have grown less frequent, though the basic themes are remarkably consistent. I expect these will dissipate down to nothing over time.

I am glad I had this surgery. My heart is in much better shape now and should stay that way for the rest of my life. I hope everyone facing it comes through as well as I have. Good luck.

I celebrated my one-year anniversary with a vigorous gym workout in the afternoon and some good wine in the evening. Throughout the day I’d flash back to what was happening at that time a year ago. It hardly seems real now—more like a strange dream. I really haven’t thought about the whole experience for months other than realizing I am so much better physically now. The sternotomy scar is barely visible. While I was in pretty good shape before the surgery, I am in even better shape now that my heart is functioning more efficiently and I am not constantly conscious of it. I am thankful that it went so well.

Based on my own experience, I’d say to anyone facing this surgery that you get through it, that you get better, and that it is well worth it. Your own attitude is a huge factor. There will be pain and discomfort, and it’ll take a while to get back to 100%, but having faith in yourself and your ability to recover is a big part of the process.

I have to remind myself that I had open-heart surgery six months ago. I am not the first to say this, but it’s remarkable how well we can heal and the memory of such a trauma can fade.

I had a mitral valve repair with a sternotomy in January, 2011. I recently saw my cardiologist for a six-month followup visit, who—after listening to my heart, reviewing my echocardiogram, and checking blood pressure and EKG—pronounced that I was doing remarkably well and he was thoroughly pleased with my recovery and heart function. He said he doesn’t need to see me again for a year. We’ll keep to that annual visit unless there’s some reason otherwise. I saw my surgeon at the end of April. He, too, said I was doing great, had recovered remarkably well, was in excellent shape, and he didn’t need to see me again.

I feel good. I am walking, biking, swimming, working out at the gym, doing yard work, and staying as physically active as I can. All of this without any need to pause and let my heart catch up in the midst of strenuous activity. I did not even realize how much that was happening before the surgery, it creeps up so slowly.

I’ve been spending time at the beach this summer. Friends who were following my surgery and recovery last January in the dead of winter see me and they, too, forget I had heart surgery. I am active and, what’s really amazing, the sternotomy scar down the center of my chest is barely visible. You have to really look to see it. The surgeon and his team at Mass General did a great job.

My mitral valve still has a slight leak. Both the surgeon and my cardiologist say this is not unusual, in fact they expected it. The leak is so minor it doesn’t affect my activity and they say it should not worsen over time. If that’s so, I am fine with it.

I still get some pain in my sternum if I exercise my chest really hard (like a bench press). They tell me the sternum is mostly healed but will not be fully so until about a year post-surgery. In the meantime I can do what I want but am supposed to be mindful of not overdoing any activity that pulls at it, which is just about any chest exercise. There’s also the issue of sudden shock. Early in June I was surf fishing from a beach on an unusually hot day. I got so warm (and wasn’t catching anything) that I dove in. While the air was unseasonably warm, the Atlantic was its usual early-summer, frigid self. The jolt of pain at the center of my chest literally took my breath away. For an instant I thought I had damaged it all over again, then realized it was just the sudden change in temperature. I’ll probably be dealing with this kind of thing for while.

Looking back, I am glad I had the surgery and—despite inconveniences of New England winter—glad I did it in January so I’d be fully healed by summer. If what my surgeon and cardiologist tell me is correct, I should not have to deal with this mitral valve problem again. That’s great news.

I’ve had steady progress in the twelve weeks since my January 18 mitral valve surgery. I seem to have reached a holding pattern as I wait to meet with my surgeon at Mass General on April 28.

I am still experiencing some chest pains that I thought would be gone by now. My cardiologist doesn’t seem too concerned. He figures part of it is normal post-surgery healing and another part is probably that I pushed a bit too much too soon as far as upper-body exertion and may have strained muscles in my chest. He suggested two weeks ago that I make a concerted effort to not strain my upper body at all and see if that reduced the pain. While it is not all gone, I admit that it has lessened substantially. It’s frustrating though. I am eager to get back to a normal level of activity as far as working out at the gym, swimming, casting a fishing rod, lifting and carrying, and just doing ordinary things without thinking all the time that I have to be careful.

I am still taking Warfarin. That should end when I meet with the surgeon in a couple weeks. It has not been too bad, but I’ll be relieved when I don’t have to take the pills every day, get tested for dosage, watch my diet (no broccoli!), and be mindful of not banging into anything so I don’t bruise (or worse).

I’ve been in a routine of alternating my four-mile walking route with visits to the gym where I concentrate on a lower-body workout. I feel like my upper half is atrophying, thought it’s probably not as bad as I picture. I do notice that my endurance is much better than pre-surgery. That’s a great relief. Spring is only just arriving in New England. I am looking forward to doing many outdoor activities once I get a clean bill of health from the surgeon.

Eight weeks since surgery and things continue to go well. I am regularly walking four miles outside. The weather is getting better—more sunny days and getting into the 50s—so that makes it easier. I alternate that with visits to the gym for a shorter walk around the indoor track and work on the leg machines. Still no upper-body work.

I did something this week that has been giving me sharp pain on the left side of my chest. I think I pulled a muscle by lifting our dog into the back of the car— a 14-year-old, 60-pound Samoyed. I’ve done this so many times that I didn’t even think about it until she was in the car and I realized that probably was not a good thing to do. I now have this pain that flares when I make any kind of twisting movement. It’s amazing how many twisting movements I can make during a day, particularly while sleeping.

Another thing, mostly a curiosity, is that I occasionally get a sharp poking feeling over my sternum. When I touch it I can feel one of the wires that’s wrapped around the bone poking up into my skin. I gently massage it until it shifts and it’s fine after that. I can actually feel the wraps of wire, which is a little strange.

That vein in my arm no longer hurts, though I also can no longer find it so I am guessing it really did atrophy. No blurry vision episodes for weeks; that seems to have gone away. Very few episodes of light-headedness when I stand, so that also seems to be getting back to normal. My energy level is improving—not where it was but much better than a few weeks ago.

Will be taking Warfarin (blood thinner) for another month. We seem to have gotten the dosage set on that. Am not taking any other meds, and have not for weeks. I have taken a couple of Acetamenophen for this chest pain and am putting heat on it in the evening.

I am looking forward to being able to do more physical things in another four weeks or so, but so far so good.

Six weeks since surgery and everything is going well. I had a checkup with my cardiologist who said my mitral valve sounds completely normal, the incision has healed well, my blood pressure is good, and everything is looking great. He was pleased, as were Susan and I.

I quit taking painkillers after about a week at home and stopped with Acetamenophen two weeks ago. There’s a very slight pressure behind my sternum sometimes, but it doesn’t really amount to anything. I still feel some pressure when I twist or turn, so I am being careful with that kind of movement. My cardiologist says it’ll take about three months for that bone to really heal.

I am walking almost four miles, but the weather continues to be uncooperative. We’re still getting snow, which is mixing more with sleet and rain and then freezing into solid ice at night, so outside walks are spotty. I am using the inside track at my gym, but after two miles it gets so boring I can’t take any more. I’ve been mixing that up with work on the leg machines at about half the weight I usually use. I’ve been avoiding upper-body work. My cardiologist says I could start with anything that’s comfortable as long as I use really light weights until about that three-month point. No swimming until after that.

The phlebitis in my right arm is either getting better or that vein is atrophying. It shocks me to think that vein could just wither away, but the docs don’t seem concerned and say that I have plenty of other veins in my arm to carry the load. The vision episodes (blurring) have mostly gone away. Feeling light-headed when standing up has gone away as well. My energy level is returning, though not back to 100% yet.

My appetite is better. I’ve even put back on a few of the ten pounds I lost. I have one glass of wine in the evening. My INR (coagulation) has leveled off and is where we want it. Another six weeks on the Warfarin, then I am done with that and don’t have to keep track of wine or green vegetables.

My surgeon doesn’t need to see me until the end of April. I’ll see the cardiologist again in July. We’ll get an echo then to see how things look. So far, so good; I hope that continues.

The stepdown unit is a floor for cardiac surgery patients who move here from the CSICU. I got rolled to the end of the hall and moved into the last room. Later that afternoon, following a nap, the nurse had me get out bed and hung the bag from the chest tubes, the catheter bag, and the pacemaker control box on a rolling stand. The wireless EKG monitor had its own pocket in the front of my Johnny. With all of this apparatus secured, we then took a very slow walk around the floor. Along the way we stopped so I could step on a scale to check my weight. I was seven pounds over when I first checked-in. I was weighed daily thereafter—because the built-in scale on my bed wasn’t working, I’d do this as part of my daily strolling routine.

I was there for two more days before being released to go home. Each morning at about 5:00, a tech would appear to draw blood. Then at 6:30 my surgeon would show up, listen to my heart, and talk to me for a few minutes. He said he was pleased with how well I was doing and encouraged me to walk as much as I could. Soon after, my cardiologist would show up and we’d have a similar discussion, although he stayed a little longer and talked more with me. My vitals were checked every two hours for the first day, then four hours after that. Nurses, aids, and techs would come and go all the time checking various things.

I was getting two Percocets every four hours for pain, as well as various other daily pills I can’t remember. The nurse would usually show up during the day at about the four-hour interval to give me those meds. At night, however, I had to buzz when we got to that point. A couple of times I let it go too long and the pain, which started as a pressure on the center of my chest and would then develop sharp edges of real pain, would get ahead of me. The Percs usually took about 30 minutes to kick in before obliterating the pain and putting me to sleep.

The second day in the stepdown, my surgeon said I could have the two chest drainage tubes removed. One of his physician assistants did that. What a strange feeling. It wasn’t exactly painful, at least not in the sharp way the chest wound would get if not medicated. She cut the sutures holding the tubes in, placed a large gauze pad over the site, and then in one swift move pulled them out. It was a brief but intense discomfort that felt like someone was pulling my insides out, which is pretty much what was happening. I looked up at the ceiling then glanced down when the tubes were out. They were big and long. An hour or so later, the nurse removed the Foley catheter. This was a similar sensation, though on a smaller scale. I was very happy to have these things gone.

With these tubes out, it was much easier to move around (though I still had to deal with the pacemaker wires and control box, as well as the EKG leads and it’s control box). I did circuits around the floor several times a day, trying to do more laps each time. The next thing was to climb the stairs at the end of the hall. My weight kept dropping each time I was weighed.

The nurses mostly seemed to work twelve-hour shifts and I saw few of them more than once. They were all great and very nice, but the issue of my low resting heart rate would sometimes get lost in these transitions, so I was constantly telling people about it. Even then, either I forgot or they did and my heart rate was often setting off an alarm and/or causing someone concern right up until the time I was released.

Because of the soreness in my chest, I could only lie on my back. Rolling to my side and sitting up to get out of bed was an effort. The nurses gave me some basic techniques for this (nose over toes) and gave me a heart pillow to clutch to my chest whenever I moved. This kept my arms crossed, holding my sternum in place.

The last full day I was there, a PA pulled the four pacemaker wires from my chest. This felt like having the tubes pulled, though on a much smaller scale. The next morning before I was released, a nurse removed the EKG leads from my chest and I was able to take a shower, which felt great. After receiving final instructions from the nurse and getting dressed (very awkwardly), I got a wheelchair ride down to the front door and released into the cold for Susan to pick me up and take me home.

I woke very early morning with a desperate thirst and I asked my nurse if I could get something to drink. She said I couldn’t have liquids yet but she’d get some ice. She gave me a small plastic teaspoon of ice chips, which was one of the best things I’ve ever tasted. I asked for more. She began to slowly feed me a series of spoons of ice chips, graduating to a plastic cup half-filled with ice and a couple ounces of water. I was so dry and thirsty—not only from not having had a drink for over 24 hours but also the drying effect of the anesthetic—I just sucked all of this down. She told me I could have more, but I needed to wait.

Fluid management is an important issue at this point. The body has a fluid buildup after surgery, which leads to postop bloating and weight gain. They want to see that excess fluid move out. This happens through the two chest tubes and the Foley catheter. The nurses were constantly checking those tubes and collection bags and recording the amounts. At one point in the morning, my nurse commented that I had excellent kidneys (apparently I was moving a lot of fluid through the catheter). My kidneys, which had never received such a nice compliment, were flush with pride.

My surgeon, Dr. Akins, appeared at 6:30 A.M. He listened to my chest, checked my chart, gave me a brief recap of the surgery, and then was gone. My cardiologist, Dr. Boucher, showed up a little while later. He, too, listened to my chest and talked with me for a while about the surgery and how things looked going forward. Everything, he said, looked very good. The surgery went well, the valve was in great shape for the repair, and though we’ll need to keep an eye on my blood pressure, my long term prospects look excellent. I asked him a few questions, and then he left.

Not long after that, a group of people in scrubs showed up for morning rounds. Mass General is a teaching hospital so this group of, I’m not sure what—surgical residents and fellows, physician assistants, maybe something else—appears every morning to discuss your case. What struck me is that while they were discussing my case, they paid absolutely no attention to me. While I was lying in bed a few feet away from them, I might as well have been a piece of furniture. At one point when they were discussing my low heart rate, I spoke (this seemed to startle them), explaining that my resting heart rate was normally around 50 and since I’d been lying in bed so long it was not surprising that it was in the 40s. They all looked at me, the one leading the discussion even acknowledged me. Soon after, a physician in a suit showed up. Apparently he was the cardiologist assigned to the CSICU. He walked in, looked at a monitor over my head, picked up the control for the pacemaker with the four wires plugged into my heart and cranked a dial. This sent a jolt to my heart almost making me pass out. I stammered that whatever he was doing was making me faint. He said something about my low heart rate and I then told him about my normal, resting, low rate. He backed the dial off, much to my relief. I realized at that point that I would need to tell everyone who dealt with me about my normal heart rate to avert this kind of concern and overreaction (as it turns out, even that would not be entirely effective). I asked my nurse, who had been quietly off to the side doing things, if all this was typical. She said it was and we got into a discussion about the benefit of recognizing a patient as a human being (this was not an issue with the nurses—they were all great).

The nurses changed shifts and Susan appeared soon after. I was much more conscious this morning so we were able to talk. The nurse asked if I wanted anything to eat. While I wasn’t very hungry, I did feel like something cool and soft. I asked for a banana and two cups of yogurt, which I devoured as soon as they were set in front of me. The charge nurse came in and removed the two IVs in my arm and the one in my neck (pulmonary artery catheter), as well as the monitor taped to my ear that is similar to the one they usually clip to you finger. Another nurse—the IV nurse—came in and inserted a new IV on my left wrist. A few other people came in to talk to me during the morning. They told me I was doing well and were planning to move me to the stepdown unit at noon. Exactly at noon, eighteen hours after arriving in the CSICU from surgery, they rolled me across the hall to a patient room in stepdown.

Four weeks after surgery and I am continuing to do well. The incision is healing very nicely and pain continues to diminish. I take 3-4 acetamenophen over the course of a day, which is about all I need. Although there are some days when I just feel tired, for the most part my energy continues to increase. I am walking over 2 miles daily and feel fine. I am at the point where I need to hold myself back so I don’t overdo it physically.

The vein in my right arm is still somewhat hard. I think it’s getting better, but the change is so slow it is difficult to tell. I am getting some random blurring of vision. This was happening frequently right after surgery, but that has also become more infrequent. Apparently this is a common aftereffect of surgery. A nap after lunch is a standard part of my day.

I had an unusual episode of pain a couple nights ago. Around 7:00 in the evening I started to have tightness and pain in the right side of my chest. I took acetamenophen which did not seem to help at all, then I took a Percocet. After about six hours we got so concerned that we were ready to call an ambulance, but first paged my cardiologist. I didn’t want to bother him, but I really didn’t know how serious this might be. He called about 1:30 A.M. After listening to my description, he said it sounded more like muscle pain than a cardiac event. At that point it had begun to lessen, either from the Perc or it had just run its course. He suggested I go in for an EKG and x-ray in the morning to be sure nothing serious was amiss. I did mange to fall asleep after that. The following morning I felt much better though very tired. The EKG and x-ray showed no problems. While I don’t recall doing anything particularly strenuous, the best guess is that it was a muscle strain that exhibited through my chest. A good reminder to pace myself and not push too hard during this healing process.

I came to a stop and was slid onto a bed. People were scurrying around, adjusting tubes and wires, checking machines surrounding me, etc. I was vaguely aware of all this as I drifted in and out of consciousness. The one constant was the hiss of the ventilator pushing air into my lungs. I know people were talking to me—telling me things, asking me things. At one point someone asked me to reach up and squeeze her fingers with each of my hands. I have a recollection of two nurses scrubbing the Betadine from my body. I think I responded to some questions by nodding or blinking or giving a thumbs-up. I couldn’t talk because of the breathing tube in my throat. It was all very hazy. I was in the cardiac surgery intensive care unit (which everyone called the “sic-u”). I had my own room—more of a bay really—that opened onto the main hallway of the csicu.

Susan appeared sometime around six in the evening (I only know this because she told me later), along with my cardiologist, Dr. Boucher. I have a vague recollection of them being there and of him asking me some things. I know they were there when I had an initial skirmish with the breathing tube.

The endotracheal tube and ventilator was one thing I was apprehensive about beforehand. I knew I’d wake up with the tube in my throat and the machine breathing for me. I knew it would be there while the anesthesia wore off and I regained the ability to breathe on my own. I knew that I should not fight it and just let it breathe for me. As someone who likes to be in control, particularly of something so fundamental as my own lungs, I didn’t know how I’d respond. During the periods I was awake, I tried to relax and let it do the work. I was also trying to regain control of my own breathing and work with it. This was fine until it and I got out of sync. I tried to inhale while it was between puffs, and I got nothing. I had an immediate panic response where I lurched up, gulping for air and biting down on the tube. This couldn’t have lasted more than a few seconds when the machine pushed new air into my lungs (I think with a jolt of sedative) and I fell back unconscious. I awoke to the nurse massaging my jaws and telling me to relax and let the machine breathe for me. After that, I just let the ventilator take the lead.

Over the course of the evening I remember touching that tube at my mouth and feeling it taped in place. At some point I began signaling a question about when it would come out. The nurses, who were very calm and attentive, let me know they’d remove it as soon as they were confident I could breathe on my own. Around midnight I became aware of the clock on the wall over the foot of my bed. At about 1:00 A.M., one of the nurses asked if I thought I could breathe all right on my own. I nodded vigorously and she told me they’d take it out at 1:30. I began watching the clock, letting the ventilator take the lead, knowing it would be out soon. A lot of activity continued around me. Remarkably, the clock seemed to have stopped. At one point I even thought it had moved backward. I knew that couldn’t be right, but I just wanted that thing out. At 1:30, one of the nurses asked if I was ready. Another vigorous nod, and she told me on the count of three to do something—I think it was cough. A nurse was on each side of me, one of them counted down, I coughed, they started to pull the tube out, I lurched up again, they kept pulling the tube, and finally (it seemed a long time though couldn’t have been more than a few seconds) the tube was out. Liberation! I fell back, breathing on my own, and drifted into sleep.

I was, of course, unconscious during surgery, but I have a copy of the surgeon’s operative report which is the source of this information.

After I was under full anesthesia, a midline incision and median sternotomy were performed. This is a procedure where an incision is made down the center of the chest and the sternum (breastbone) is cut and expanded to reveal the chest cavity. The pericardium (the sac enveloping the heart) was cut open. Appropriate lines were placed for diverting blood and I was put on cardiopulmonary bypass (the heart-lung machine, or “pump”). I was cooled to 30 degrees C (86 degrees F) and my heart was stopped. An incision was made in the left atrium to reveal the mitral valve. The posterior leaflet was resected (repaired), the leaflets adjusted to fit, and an annuloplasty ring was seated at the base of the valve. I was rewarmed and brought off of bypass after an hour and twenty minutes on the pump. A transesophageal echocardiogram showed the regurgitation had been corrected. Four pacing wires were placed on the heart, as well as two chest catheters (drainage tubes) put in place. The incisions were closed and the sternum wired together. The whole operation was, I believe, about four hours. (NB: This is my own simplified version of the report. Any inaccuracies are mine.)

I began to wake rolling along a hallway, lights flashing overhead, cool air pumping into my lungs, bags and tubes hanging from posts on the side of the gurney, and what seemed like a lot of people pushing me along. One of these people—I am guessing it was one of the nurses I was talking to before going into the OR—leaned down and told me the surgeon had done the repair. I either nodded or gave a thumbs-up, I don’t really remember, to acknowledge this and thank her. She knew I wanted the repair and was hoping the surgeon would not have to do a replacement. I was in and out of consciousness as they moved me to the intensive care unit.

I am summarizing my recollections of surgery, as a number of people have asked about this and I found it very helpful before my own surgery to read about others’ experience.

I had mitral valve repair surgery with Dr. Cary Akins at Mass General Hospital in Boston on January 18, 2011. Susan and I arrived at the same day surgery unit at 08:00 that morning. They checked me in, gave me a wrist ID bracelet, got me into a hospital johnny, robe, and slippers, and did an admittance interview. I was told my surgery would be around noon, but that depended on when the earlier surgery got done. At about 10:30 I got called back—Susan came with me—where I was put on a gurney, had my ID checked and had another put on my ankle, given some gargle, and issued a surgical cap. Susan and I said goodbye and I was rolled away.

After a maze of hallways, we broke through the doors into the surgery unit where the air temp dropped noticeably. Manny, who had me at this point, moved me into a curtained area, told me to take off everything I was wearing, and covered me in a hot blanket. He then proceeded to shave me from neck to ankles and paint my entire body with ice-cold Betadine. I glanced down and thought I looked something like a cooked lobster, which, as I was about to have my chest cracked open, seemed a fitting image. The anesthesiology resident stuck a couple of IVs in my arm, told me what else would be plugged into me once I was unconscious, and explained how that part of the process would work. Various nurses, docs, and others checked my ID, asked questions, filled out forms, looked at my patient binder, connected me to various wires and tubes, etc. There was some delay in preparing the OR, so I stared at the monitor showing my vital signs and chatted with a couple of the nurses who were very good about bringing more hot blankets. Then the anesthesiologist showed up along with his resident and various nurses. The resident said I was about to feel like I drank a six-pack of beer all at once as he turned on the happy juice, and they rolled me down the hall to the OR.

I remember rolling through the doors into the OR, which was large and bright and cold with machines all over the place and many people bustling around. I know the anesthesiologist was talking to me, asking questions, and I was trying to respond as they were moving me into position for surgery. That is where I slipped into oblivion.

The incision looks good. I have a better range of movement. My appetite is better. The chest pain is much less. I’ve quit taking Percocet and am on one acetamenophen every six hours or so. The past couple of nights I’ve been able to, very carefully, turn on my side clutching a pillow to my chest and sleep that way for a while, finally getting off my back.

The thrombophlebitis in my right arm is still there. I am putting heat on it every evening and exercising it as much as possible to improve circulation. It seems to be loosening. My arm hasn’t turned green or fallen off, so I guess that’s a good sign. I am not too concerned, but I’d like to get that back to normal.

I’ve walked two miles on our road the last couple of days. I carry an old cane that had belonged to Susan’s father to give me extra balance over icy patches. I picture myself as a boulevardier with a jaunty walking stick strolling down our country road. Drivers probably see some idiot in a red parka and cane daring to be hurled into a snowbank. Perspective is everything.

I still tire easily and take a power nap after lunch, but I can feel that I am gaining a little more energy each day. I should be able to drive next week, freeing Susan from her chauffeur duty. It is slow and steady, but I see progress.

Two weeks today since surgery. Walked 1.25 miles yesterday along our road, which was briefly free of snow and ice. About a foot of snow today and another foot predicted for tomorrow, so we’re housebound for a couple of days.

Slow and steady progress on all fronts: less pain, better movement, not quite as tired, better appetite. I am taking only Acetamenophen during the day and one Percocet last night. I am hoping to be able to sleep on my side soon.

Visited my primary care physician yesterday for an INR (blood thinner) test and to touch base after surgery. He thought I was doing well: no fluid buildup in chest, blood pressure and heart rate good, overall in good shape for two weeks postop.

The one concern I had for him was that the vein on the inside my right arm is hard and slightly sore. It feels like a rope or rubber tube under my skin. When I went to the blood lab last week, they were unable to draw any blood from it. This happened once in the hospital, too, though there was so much else going on I did not remember it. Apparently this is a thrombophlebitis, or superficial phlebitis, which is common after an IV and catheter have been inserted into a vein for surgery. The vein becomes irritated and forms clots which harden and block blood flow. He didn’t seem too concerned about it and said these usually resolve themselves, though it has been two weeks. I am putting heat on it and trying to exercise my forearm to keep the blood moving. I’ll call my cardiologist tomorrow to see what he has to say. Anybody else have experience with this?

The hardest thing is pacing myself and not expecting too much too soon, but overall I am happy with recovery so far.

Eleven days since surgery; one week home. I am making progress, though I need to keep reminding myself it is a slow and long process. In daily increments, I can feel the pain diminishing, not quite so exhausted by any activity, a little more strength returning, less need for pain meds, I can reach things higher on the shelf, hoarseness doesn’t seem quite as bad, a bit easier sleeping.

Cold temps and several feet of snow on the ground are keeping me from simple walks out the door and down the street. That’s frustrating, but I knew that could happen when I scheduled the surgery for January. Susan took me to my gym today where I walked a mile on the indoor track and did a few leg exercises with very light weights. While I was tired afterward, it felt great.

I have not had a big appetite and Susan is concerned that I’ve lost about ten pounds since surgery. I was fairly lean to begin with, so I’ve been working to eat to resupply my body that is burning calories in an effort to heal all this trauma. I’ve read in other journals that weight loss is common, so I am not too concerned.

I am taking only Acetamenophen during the day. Still need a couple of Percocets to get me through the night. I lost track a couple of times during the day so that a pressing chest pain caught up with me. It’s surprising how suddenly that can hit the pain threshold. The Acetamenophen handles it pretty well. Talk about pain threshold, a sneeze suddenly came upon me while I was standing in the kitchen. It threw me to the floor, gasping, on all fours with a searing pain in my sternum. Thankfully it passed quickly. I’ve been trying not to sneeze since.

The surgeon told me not to drive for a month. Susan has been great driving me around as needed, but this is all a strain on her and I’ll be glad when I can relieve her of that shuttle duty. In all, things are going well and I need to keep pacing myself toward full recovery.

I’ve been home now for three days; surgery was one week ago today. Everything has been fine, though I need to be mindful of knowing my limitations. Certain things I am so used to doing that I don’t even think about can be a problem, like reaching and twisting. I’ve found that reaching for something on an upper shelf, reaching out to pet the dog, or twisting to look over my shoulder in the car all give me a sudden jolt of pain in the sternum. Knowing my limitations means readjusting them to this new situation, so there’s a learning curve.

Pain and tightness are still there, though noticeably diminishing. I am taking fewer Percs and phasing in Acetaminophen. I find I still need the Percs for sleep, though not as many even for that (unfortunately I am still on my back).

It’s inconvenient to have the INR blood test for coagulation level every couple of days until they get the blood-thinner dosage evened out. There’s a lab not too far where I can have this done and, as Susan pointed out, it gives me another reason to get out of the house and moving around. Once the dosage is established I’ll need less frequent testing. The whole blood-thinner thing should be over within three months.

Walked a half-mile on the indoor track at my gym today. I definitely won the prize for slowest moving. It was frustrating to be there and not able to do anything like my regular workout; on the other hand it’s amazing that I was at the gym at all a week after open-heart surgery. Another 15 inches of snow predicted for tomorrow night, so looks like the indoor track, along with stairs at home and the spirometer, will be my exercise for a while. Had lunch when we got home and then fell into a deep (and Perc abetted) nap.

While I am an avid reader, I found in the hospital that I couldn’t concentrate on more than a page or two before my mind drifted (of course being in a hospital has a myriad of interruptions all its own). That turned out to be mostly news magazines that had pieces just about that length. Thankfully, I can now concentrate enough to be reading a book.

I have a slight hoarseness to my voice. I think I read somewhere that all of the tubes that are inserted down your throat during surgery can bruise the vocal chords. It doesn’t hurt, but is definitely there. I am assuming this will pass.

I feel good about the way it is all going and am trying to be mindful of pacing myself over the next few months. Thanks again to everyone for the many messages of support and encouragement. They really mean a lot.

It’s great to be home! Hard to believe I was being rolled into the OR for mitral valve surgery Tuesday afternoon and am home Saturday afternoon. My thanks to all who have been offering support and encouragement. It is really, really nice to hear from so many of you.

I find I am very tired, as everyone had warned. My first shower at the hospital Saturday morning felt wonderful, but I was exhausted afterward. The hourlong ride home that afternoon really took it out of me too, and all I was doing was sitting (in the backseat) while Susan drove.

It was nice to be in my own bed for my first night home, but I can only lie on my back because the sternotomy incision is still sore and tight and I have to avoid twisting or pulling it. I am a front/side sleeper, so as the Percocet started to wear off I’d awake and flail like a turtle on its back as I tried to find a more comfortable position. Many people have advised me to keep taking the pain meds, which not only reduce the pain but also knock me out. I am trying to reduce the amount—which seems to be working—while sticking pretty much to the schedule I’d been on in the hospital. Susan is being very good about reminding me to stay ahead of the pain, righting me when I do the funky turtle, and generally looking after me.

Pretty lazy day today. The exterior temp is just above zero, so no outside walks. I’ve been climbing stairs and using the spirometer, with a nap after lunch. Read the Sunday papers this morning. Two NFL playoff games this afternoon. I plan to stay awake for those as much as I can, even though the Patriots got knocked out last week. I am glad to be on the other side of this surgery. I’ll post again when I have a bit more energy and lucidity.

Jim found out late this morning that he could come home today. Got home about 3:30, and Jim was tired after the longish ride, exposure to cold, etc. So after we figured out just how many pillows he would want, he took a little snooze while I went out to procure prescriptions (percocet, coumadin).
Our cable wasn't working this afternoon (grr), but now it's back. Jim asked me to do the post about his being discharged.
Can't believe he had the surgery Tuesday and is home on Saturday. Unbelievable! So now onto recovery.I think from here on in, Jim will resume authorship of the journal. Thanks again to all of you.

Because of the snowstorm here, I didn't go into Boston today. But Jim's continuing his great progress. The wires that provided an external pacemaker were removed around noon. The nurse says that unless he experiences arrhythmia (which often occurs), he will likely be discharged either tomorrow (Saturday) or Sunday.
When we have further word, I'll give you an update.

Susan here, because I have the laptop (my only computer). Jim's now without one 'til I get there.
Only one post today for two reasons. First, the internet connection wasn't cooperating well today. And second, Jim's making great and steady progress, but there aren't as many landmark events. He's off all tubes now and walking 3 or 4 laps around the unit several times a day. On percocet and only slightly but adorably stoned.
Snowstorm predicted for tonight through tomorrow, so I may not be going to Boston tomorrow. If not, I'll post instead of Jim.

Greetings to all and thanks so much for all of your encouragement and support.

As Susan said, I was good for the mitral valve repair which is great, exactly what we wanted. It all went well and surgery was done about 5:30 PM Tuesday, then I got moved to the cardiac ICU overnight for constant monitoring. Everyone was great and said I was doing really well.

I got moved from cardiac ICU to the step-down unit in record time. Wednesday morning I was seen by many people who listened, checked, pulled out some lines and stuck in some others, and generally gave me a thorough going over. I got moved to the step-down unit at noon. I was up and walking around that afternoon. Not a good night's sleep, as I had vital signs checked every two hours along with various other tests, but everyone at MGH is very nice and professional.

This morning (Weds) Dr. Akins stopped by early and said I was doing great, as well as my cardiologist (Dr. Boucher) who also said I was doing great. The two chest tubes and catheter were pulled this morning. I still have wires implanted for a pacemaker and EKG leads stuck on my upper body. They'll probably leave those until I leave. I did four laps around the floor this morning and will walk some more this afternoon. They want me to walk as much as I can, which is fine as I get antsy lying around. Not sure yet when I'll be out of here—could be the weekend—but everything is going well.

Again, thanks to all for your notes. I really appreciate hearing from you. I'll post again when I can.

We've gotten some nice posts without names. If you don't sign your name, it doesn't show up, so you're anonymous. If that's your preference (what, are you wanted by the Feds?) ok; otherwise supply name(s).

I left the hospital to come home to Bolton a little after 7:00. Jim had eaten a full dinner and was getting very sleepy from the percocet he'd been given. Time for him to get a little sleep before tonight's routine of being awakened every two hours for vitals.
He's the star of the cardiac unit, with all being amazed at his progress (me too).
I'll be going in mid-morning tomorrow, so no new posts til then.

Jim's been here for a couple of hours (couldn't get internet access). Next to the window. He's tired and looking forward to his first nap of the day. Didn't get one earlier—lots of people doing lots of good stuff to him in ICU. Step-down means a bit less interruption. He's supposed to get up and walk this evening.
Had a good lunch of soup, turkey sandwich, and tea. Doing well.

Jim out of the ICU and being moved to the step-down unit. Earlier than we'd thought because he's doing really well. He's off most of the equipment he was hooked up to. Really good, attentive care here.
He'll have to be on coumadin for about 3 months but no ban on wine (he was glad to hear that) or physical activity other than contact sports or skiing. It's really hard to believe that surgery was less than 24 hours ago!
Thanks for all your messages; he read them all.

Jim is awake, completely lucid, and has just eaten a banana and two yogurts. Breathing tube out about 1:30 last night. Chest tube comes out later this morning. He will likely move from Cardiac ICU to the Cardiac Stepdown Unit (excellent news!). He's doing incredibly well (what a difference a day makes!).
When I asked Jim just now if he'd like to give you all a message, he insisted on reading all of my posts (same guy, even less than 24 hours post-op). He said to tell you he's well, thank you for your thoughts, and he's sleepy, but fine.
I'll post again when he moves.

Just spoke with Jim's surgeon, who said he did the valve repair (rather than the replacement). This is what we had hoped could be done, so excellent news. I feel like jumping up and down and whooping for joy. All is well, and thanks to everyone for their prayers and good thoughts.
I can see Jim in about an hour, though he won't be conscious and won't be until tomorrow morning as expected. I'll add one more post tonight and then resume tomorrow morning.

Jim's surgery started at 1:35. There's a delay between the time things start and the time they get posted here, and the internet connection is off and on, so my posts may be delayed a bit, too. The surgery will be 4-7 hours, depending on the procedure. Back later.
Meanwhile an interesting story. I've been sitting all day next to a woman, and we've been chatting and joking. She said in passing that she used to be in politics. Later I asked what office she had held, and she replied, "I was governor of Massachusetts." Jane Swift. We both burst out laughing. Very nice woman, looks younger and better in person (probably because she's out of politics.).
More later.

Susan and I are sitting in the surgery waiting area. I'm tres chic in my hospital johhny, robe, and pants. Got to MGH at 08:00 through a modest snowfall. Not too bad, particularly considering the blizzard earlier this week. Surgery should be around noon, depending on the surgeon's earlier operation. They'll be taking me for all the prep stuff before too long. Susan will take over updates after that. I'll post again as soon as I am able. See you all later.

Susan and I left the house at 05:30 on Jan 13 to be at Mass General by 07:00 for my preop testing and interviews. We’d left extra time to get into Boston because we’d had almost two feet of snow from the previous day’s blizzard and didn’t know what the road condition would be. As it turns out, the roads were very clear and easily drivable. Kudos to all of the snowplow crews in our area.

For the first three hours I got processed very efficiently: blood, urine, blood pressure, EKG, X-ray, admitting nurse interview, surgeon’s PA interview and exam, and anesthesiology interview. The surgeon (Cary Akins) got delayed in a meeting and then had to go into surgery at 10:00, so we wandered around for the next three hours, explored the hospital, found the surgery family waiting area, then back to the surgeon’s waiting room.

At 13:30 his PA asked that I come in alone. Akins gave me a quick exam, then told me he wasn’t sure if he’d be able to do a repair because of an endocarditis incident I had last spring. He said this often damages the leaflets in a way that can’t be seen on an echo and that I should be prepared for the possibility of a replacement. He wouldn’t know until he actually got in and saw the valve during surgery. We talked about this and the options (biological vs mechanical) for a replacement valve. He said I needed to think about it and get back to him with my choice. Seemed odd to me that this was coming up just a few days before surgery (Jan 18), but then I’ve never been through this before. I spoke with the two cardiologists I’ve been working with, Susan and I discussed between us, and we came to the decision to opt for the biological valve. This is because I am physically active, enjoy outdoor activities, and do not want to be burdened with taking a blood thinner the rest of my life and all that would entail. The downside is that biological valves have a life expectancy of about 10-15 years at which point I’d have to have something done again. Akins explained that if I went that route, by the time I’d need more work there might very well be a catheterization option for mitral valve work (as opposed to the ministernotomy I’ll be having this time).

The following morning (Jan 14), I faxed a letter to Akins stating my strong preference for a repair and, if that were not possible, that I’d want a biological valve. His PA phoned to say they had received that letter and that they had rescheduled me for the second operation of the day rather than the first. I would have preferred to remain first, but on the other hand that means we can be at the hospital at 08:00 rather than 05:30. So now we are taking care of things at home and trying not to focus too much on next Tuesday, but rather on the recovery period and getting back to normal afterward.

With surgery now just a week off and a couple of other family things going on, I realized I was feeling increasingly stressed and needed some relief. I’m an avid fisherman and always feel relaxed being on the water, so…

I met my friend Mark at his Cape Cod home so we could go out to collect oysters at midmorning low tide. A blizzard is predicted for tonight, but today was calm under a pewter sky with crisp, salty air holding right at freezing. In multiple layers and insulated waders, we crunched across snow-crusted marsh grass and icy beach mud until we got to the point of the bay where we were going to start wading. Windowpane-thick ice extended about 30 yards out. Using our rakes as ice breakers, we cut a path to thigh-deep water where we each filled our baskets with nice-sized oysters and a few quahogs (clams) before turning back to the beach. Mark, who is apparently wiser than I, waded back in the channel he had cut. I had looped around as I was raking, so had to cut a new channel back in. We walked back to his truck with two heaping baskets of shellfish. Susan and I will enjoy these all week and, for me, just thinking of being out on the water is calming.

My 59th birthday. Surgery is two weeks from today. I believe the surgeon has everything he needs from me for now. I go into Mass General next week for a battery of preop tests. Next will be the actual surgery.

Visited the dentist today for a cleaning/checkup I had put off until closer to surgery since the surgeon needs a letter from my dentist saying my mouth is free of infection or related problems and they wanted that closer to the surgery date. Everything went fine until I was getting out of the chair and the dentist said "Oops." Turns out when looking at the x-ray she saw a tiny cavity at the edge of a filling I've probably had since first grade. She made arrangements to get me in day after tomorrow to have that filled. With that, I should have a clean bill of oral health from her.

Had a new echocardiogram at my cardiologist's office last week. The tech showed me the floppy posterior leaflet in my mitral valve. That, I assume, is the one that will get the nip-and-tuck from the surgeon. She said the valve looks very clean. This is good, as I had an endocarditis scare last spring but everyone said they found no valve damage from that. The cardiologist says the echo looks unchanged from last June, which is also good. Means no further deterioration.

I'll be undergoing mitral valve repair surgery with Dr. Cary Akins at Mass General Hospital in Boston on January 18, 2011.

Because I am "young," as they keep telling me (I am 58), and am otherwise in very good shape, repairing my mitral valve is the preferable option (vs replacing it). That way no foreign valve is introduced into my heart and I would not have to undergo the use of blood thinners. The long-term prospects for living a normal and healthy life with this surgery are excellent.

I can't say that I am looking forward to it, but I have accepted that this repair is the best decision and am trying to focus on getting through the surgery and recovering as quickly as possible. I have faith in my surgeon and hospital—and my wife, family, and friends—so am confident of a quick recovery and positive outcome.